New Advantage Plan New Referrals

I got a call Friday evening from a very upset client who said her doctor’s office told her they were having problems with her new Medicare Advantage plan. The doctor’s staff said they could not get through to the plan to verify her enrollment and they could not give her a referral to her specialists.

All this is the aftermath of the Medicare Open Enrollment Period when thousands of seniors in Tucson changed their Medicare Advantage plan, effective January 1, 2015.

I have told my clients that having enrolled in a new advantage plan new referrals will be required to see their specialists. I have also to told them that the staff in their primary care doctor’s office are going to be overwhelmed with these requests in early-January. It turns out they are also overwhelmed by having to “verify” that each patient is enrolled in their new Medicare Advantage plan.

My client left her doctor’s office confused, concerned, and angry. The doctor’s office staff said they could not get through to the Advantage plan to verify her enrollment. They also said they did not know the referral process for the new plan.

As it turns out, the Medicare Advantage plan has held training with managers at provider groups, but it sounds like the information has not been shared with everyone – especially those on the front lines who actually deal with patients. And it sounds like the Medicare Advantage plan phone is overwhelmed with thousands of verification phone calls and referral paperwork too.

I turns out this problem is part of a “perfect storm” in Tucson resulting from several events:

1) Health Net cancelled three Medicare Advantage plans in Tucson, forcing thousands of its members to find a new plan.

2) Health Net lost its contract with Arizona Community Physicians, forcing more of its members to change their plan, or change their primary care doctor.

3) SCAN changed its primary care network, requiring hundreds of its members in Tucson (and in Phoenix) to change their plan if they wanted to keep their doctor.

4) UnitedHealthcare changed one of its Advantage plans from $0 premium to $39, so hundreds, if not thousands, of people moved from that plan to another plan.

5) Blue Cross Blue Shield of Arizona entered the Tucson Medicare Advantage market with perfect/lucky timing and enrolled 9,000 people into their plan.

With over 10,000 seniors in Tucson moving to new Medicare Advantage plans, there is now a tidal wave of work for the staff at primary care doctors’ offices. I’m sure the staff are not happy with the added work, but they should not be sharing their displeasure with elderly patients. But Blue Cross Blue Cross Blue Shield of Arizona better make some changes so they can handle all the calls they are getting. Everybody is going to look bad if this storm goes on much longer.

Denise

Denise Early is an independent insurance broker in Tucson, Arizona. She is interested in policy and the politics of Medicare. She enjoys telling the stories of people she meets and sees herself as an advocate for her clients. She served in the Peace Corps and has a Masters degree in International Management.

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Medicareblog.org is not affiliated with Medicare or Social Security. Posts on this blog are meant to provide information and insight into many aspects of Medicare. Denise s a licensed insurance agent in Arizona.